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#1 gcv-border

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Posted 25 August 2017 - 09:21 PM

Recently had an issue with one of my boys where I thought he was peeing in the house - maybe because of a UTI?  (His sample was negative.)

 

I collected a morning urine sample and called my vet to make arrangements to drop it off for analysis. I was surprised to hear that they would not analyze his sample unless he came in for a check-up. What?? I pushed back since he had just been in for a check up and a vaccination 6 - 8 weeks prior. I also countered that I could just drop off a fecal without getting a check-up, why did I need a check-up for a urine sample?

 

The vet on duty was not my usual vet, and I have had one appointment with her where I came out with a bill that was probably 3-4 times what I expected. She kept suggesting another diagnostic test, one after the other. My brain was not working in a logical manner, and I just agreed to everything. Hindsight regrets.

 

Luckily, the vet I usually see happened to be calling in (it was her day off), and the receptionist asked her if I could just drop off the sample without an appointment. She agreed "for this time".

 

I remember with another dog, another vet, I would just drop off a urine sample for analysis. That was 4 years ago. Is there a trend to bring dogs in for a check-up (and more $) before analyzing urine or fecal sample?  I guess I could understand this if the vet had not seen the dog for a long time, but my dog had just been in 6-8 weeks ago. Or would you attribute this policy to this individual vet practice.

 

I like this vet, but there seem to be too many requirements for check-ups and vaccinations which I think are unnecessary. I have had to push back many times against these policies, and quite frankly, am wondering if I can find another vet with more agreeable policies.

 

Your experience?  Thanks in advance.


Jovi

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#2 denice

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Posted 26 August 2017 - 06:52 AM

While there are 'professional' in every business more concerned about money than anything else most good vets have the animals best interest at heart.

To give you their best advice, make the best recommendations seeing the animal is the best path.  Lots of info is obtained by seeing the animal - physical, temp, history,ect.  Then the urine sample was it a catch sample or sucked up ...how it was collected can influence results, collected straight from the bladder is best - most accurate.

 

Add to that the vet is LIABLE.  if they miss something, do not give you the correct info, treat incorrectly...it is their butt and their license and reputation....  Gone are the days of just calling in having them diagnosis without seeing the dog. 



#3 Blackdawgs

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Posted 26 August 2017 - 07:16 AM

I've been dropping off urine and stool samples for years.  But, these are dogs that are very well-known to the vet and are in her office multiple times a year.



#4 waffles

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Posted 26 August 2017 - 09:56 AM

Maybe I'm a negative Nancy but I think it's more about money. My vet would have said the same thing about bringing the dog in again. The only time they don't charge a second office exam is if they request to see the animal in a week or two for a recheck on something.

Vets in my area charge $45-75 per office exam. Routine visits make up the bulk of my vets practice so those fees really add up to their overall income. My vet doesn't even give a discount if I bring two cats in for routine vaccines. I see him for maybe 10 min and he just got $80 from just the exam fee alone.

With that said, I love my vet and understand it costs a lot of money to run a vet practice so I pay and grumble to myself. It's the cost of pet ownership unfortunately. It's also why I also use the low cost clinic at Tractor Supply and also do many things myself at home.

I had a similar experience with my own doctor last year. We have private insurance that doesn't cover much beyond "preventative" until we meet our deductible. I went in last year to get a refill of my eczema rx which is something I have had for over a decade. They still require I come in and bill me $110 so i can tell the doctor I still have eczema. I asked the doctor to fill the Rx for several years worth of the stuff because I said I'm not able to pay the office fee each year just to get it. :)

The great thing is that our insurance company recently started the TeleDoc program for situations just like this. I can call and video chat with a doctor from home who will write the Rx and that "visit" is only $40!

I don't see why in vet care they can't do something similar. I have noticed that some vets here have "tech visits" where you don't see the actual vet, just a vet tech for routine things like vaccines. It costs about half the price of a regular exam fee.

#5 CptJack

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Posted 26 August 2017 - 05:04 PM

I am not going to discount the possibility of it being about the money in some cases, but -

 

I do not know details of specifics or locations but it is illegal for a vet to prescribe for a patient they do not have a 'valid' relationship with.  There are undoubtedly specifics about what constitutes valid, and I know for sure one of them has to do with in person, in face, visits, but I do know most of them.   That should be easy enough to find out, but I imagine that knowing that vets are reluctant to do things like run lab work and then prescribe very many time without at least a cursory exam. 

 

Many, many, people will use vets to get meds.   This is mostly a (major) problem with things like tramadol which have recreational usage and, uh, re-sale value.  I don't imagine that's likely dealing with a UTI, since there has got to be a cheaper way to get antibiotics, but if they wanted to or even thought they MIGHT need to prescribe something else, it's important.  Also pretty relevant in general when it comes to them not just giving you medicine after talking. 

 

And finally, depending on dogs age and what that last checkup involved it could actually be relevant.  If the bloodwork didn't involve liver and kidney values, particularly kidney values, it could impact both Dx and Rx.  

 

All that said, the last time I was at my vet my bill was twice what I expected.  Because I went to get a DAPP shot and came out with DAPP + a corona virus vaccine I wasn't asked about or informed was happening, and it bugged me a little.  It bugged me a LOT when we had an office visit for one dog, the other dog got an upset stomach, he told us to bring her along.  He didn't so much as touch her, he asked three questions while he examined the actually ill dog, did NOT run a fecal and charged us a full office visit fee and a stupid high markup on over the counter probitiotics I also didn't ask for or want, and wasn't asked if I wanted.    Had the bill not been itemized I would have never noticed or  questioned-since the rest of the visit for a dog with a surgery and a lot of labwork and medication - but since it was?  BUGGED.  


That said, (again), I do like my vet and ironically for all this he has given us breaks at various points when bills were getting ridiculous.  It's honestly the inconsistency of some stuff that bothers me.   When is there sometimes an office visit fee and sometimes not, for instance?  



#6 GentleLake

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Posted 26 August 2017 - 05:28 PM

CptJack, did you question the charges for the things you didn't authorize and ask for a refund?

 

I recently had a similar experience. Took a dog in for a tooth extraction and was billed for both the extraction and a cleaning. I was livid. My dogs are raw fed and their teeth and gums are perfect (well except for that broken tooth). I questioned the vet about it and asked her specifically whether there was any tartar or clinical reason to suggest that scaling needed to be done. She said no.

 

In this case it was a miscommunication between vets. A different vet did the intake and without asking me added the cleaning. The vet whom I'd been dealing with wondered why the cleaning had been added, both because she knew we hadn't discussed it and because she could see it wasn't necessary. She said she'd thought about calling me to confirm but didn't.

 

They refunded me the money for the procedure I hadn't asked for.

 

I think too few people question these things, which allows vets and other businesses to get away with padding their charges. I see it all the time in automotive repair -- go in for an oil change and you get billed for topping off fluids. They charge more for a few ounces of windshield washer fluid than I can purchase a whole gallon of the stuff for, without asking first.

 

If I don't authorize it, I don't pay for it. Doesn't matter if it's for my car or for my dog.

 

Same with meds. They often charge much more for meds dispensed from the vet than you can get from a pharmacy. They have to give you a script if you ask for it. In my area I've found Wal-Mart's pharmacy to be much cheaper than any of the others and definitely less than the vet. $10 for a 90 day supply of fluoxetine, for example.


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#7 CptJack

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Posted 26 August 2017 - 05:33 PM

I did not bother with the additional vaccination, because I didn't particularly care, and I couldn't exactly give it back.  I made it known that I'd appreciate a heads up on these things in the future so I can make a decision but got on with my life. 

 

I absolutely handed the marked up probiotics back and did not pay for them. 

 


And yes, very much to just filling any Rx at a real drug store that can be.   Walmart's pharmacy is better, but even Walgreens is cheaper than the vet dispensing most things.



#8 LauraV

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Posted 26 August 2017 - 06:49 PM

I am very picky about my vet. I've have had some very bad experiences and only trust 2. I had one vet tell me to euthanize my one dog when he was 13 because there was nothing she was willing to try to help alleviate his arthritis. Needless to say, we never saw her again. He went on to live 3 and a half more years until nothing helped anymore.

Anyways, I think that your vet should trust you and your decisions in regards to what you think your pet needs because you know them best. Any vet looking to nickel and dime you isn't the vet for you.

#9 urge to herd

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Posted 27 August 2017 - 10:09 PM

Terrierman aka Patrick Burns has several blog posts about veterinarians' financial practices. Not complimentary. Check him out.

 

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#10 Liz P

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Posted 27 August 2017 - 10:22 PM

It's not that simple.

 

Uncomplicated urinary tract infections are rare in males.  There is usually something else going on, and doing a thorough physical exam and taking a history is key in finding the correct diagnosis.

Unless I have an established relationship with a client and their pet, we already know the cause of repeated UTIs and how to best deal with them, have worked out a game plan and the dog is current on an exam, I won't let them just drop off a sample.  That makes for poor medicine.  Things get missed.  Dogs can get worse or die if critical information gets missed.  It has nothing to do with being greedy and everything to do with practicing good medicine.

 

GentleLake, yes, doing something you did not authorize is wrong.  I won't disagree with that.  However, your assumption that just because you feed raw and your dog's teeth look good it means they are healthy is not correct.  I worked at a hospital where were testing some new technology: test strips that detected byproducts of the bacteria that cause periodontal disease.  We used the strips on all dogs coming in for wellness exams and scored them.  Those scores were compared to full mouth radiographs and other information collected on our dental cases.  I was surprised by the number of dogs who had high scores (bad) on the strips that had pretty looking teeth.  Two of them were my own dogs, whose teeth looked quite pristine due to raw bone consumption.  The dogs who scored high on the strips did indeed have significant periodontal disease (bone loss, pocketing, etc) that could only be detected during a thorough dental that included rads.  Cleaning those teeth *below the gum line* and applying specialized antibiotic products will help save them.  



#11 Liz P

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Posted 27 August 2017 - 10:42 PM

"And yes, very much to just filling any Rx at a real drug store that can be.   Walmart's pharmacy is better, but even Walgreens is cheaper than the vet dispensing most things."

 

The old business model in vet med was to charge relatively little for services like exams and earn the profit on marked up products like drugs.  As consumers purchase drugs elsewhere, from places like Walmart, the times are changing.  Walmart and other big retailers can use their vast purchasing power to get better prices than small mom and pop vet hospitals.  They can also take losses on drugs, making up for it with impulse purchases on other items.  Vets can't sell for less than what they pay.  What does that mean for you, the clients?  We can't operate hospitals at a loss.  Salaries need to get paid, as do water bills, mortgages/rent, equipment companies, etc.  So how is a vet to make money?  They raise the fees for their services.  Yes, vets have to make a living too.  They have families to feed, bills to pay.



#12 CptJack

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Posted 27 August 2017 - 11:00 PM

I have no problem with vet prices in general - in fact, short of the times there was something I didn't ask for or wasn't told I was being given and then being asked for, I don't believe I've ever complained.  I know vets are far from raking in money when dealing with student debt, and operating businesses.  As well as dealing with people complaining that they're in it for the money and working in a really emotionally brutal field.


...But I'm still going to take the lowest cost option available to me when it comes to filling ongoing/long term prescriptions. A course of  antibiotics, steroids, sucralfate, whatever it is a course of?  Picking it up from the vet - the mark up isn't very high and it's just as easy to grab when prescribed, anyway.  The stuff my dog is going to be on for weeks and years? Probably going through a pharmacy, though only part of that's financial - the rest is the fact that going to the vet to pick up meds is way less convenient, given their office/dispensing hours (ie: I'm at work while they're open for non-emergencies and while I will take the time from work to take the dog to the vet taking it to pick up meds if there's another option isn't something I'm prepared to do) - though I suppose a moot point in some ways since things like Walmart have already done the 'job' (damage? whatever) of making other vet services more expensive.



#13 Smalahundur

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Posted 28 August 2017 - 06:00 AM

Terrierman aka Patrick Burns has several blog posts about veterinarians' financial practices. Not complimentary. Check him out.
 
R & G

I follow his blog, quite fun and interesting.
He paints a rather bleak picture of veterinary practice in the US. Is it really that bad? I only have experience with Icelandic rural vets, and thankfully nothing like he describes.

"Milli manns og hests og hunds hangir leyniþráður"


#14 mum24dog

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Posted 28 August 2017 - 08:32 AM

I rarely follow his blog now as he comes over as such an angry person and is not always nearly as well informed as he would have us believe.



#15 Liz P

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Posted 28 August 2017 - 08:43 AM

Smalahunder, no, it's not. Most vets keep their prices so low compared to their costs that the profession is hemorrhaging skilled employees, there is little to no profit margin and we cannot afford to pay back our student loans. We are actually drastically undercharge for our services. If something doesn't change, the profession will implode or will no longer attract the best and the brightest.

#16 juliepoudrier

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Posted 28 August 2017 - 09:14 AM

Smalahundur,

In my experience what vet practices charge for services very much depends on where they are located and the relative wealth of their clientele. For example, a vet acupuncture visit that cost me $35-40 in NC or rural VA costs $100 near Charlottesville, VA (wealthy surrounding population). An ultrasound I got at a specialty practice cost double ($700 vs. $300) what it cost at my regular vet. In defense of the specialty practice, I guess they had to pay for their instrument and the local rural vets used a traveling ultrasound vet (although that vet had to pay for his/her machine too). My local vet hired an office manager and a second vet and the prices went up, unsurprisingly. In general, that practice's surgical fees, at least, are still much lower than they are in nearby Richmond, VA.

 

Another observation I've made is that mixed vet practices, or vets who work on farm animals as well as pets, tend to be less pushy about sending clients to specialists or suggesting more expensive treatments. I think this is likely due to their experiences with farm animals, which, generally speaking (horses and some others excepted) aren't worth enough money to make it practical to spend a great deal on veterinary care for them. That's not to say that I think vets shouldn't offer more expensive treatment options, but I, for one, appreciate a more practical outlook at times. When my Willow was being treated for mast cell cancer and the last treatment we tried made her quite ill (without doing anything to the tumors), the specialty practice pushed additional treatments. I went back to my regular vet and had a very frank discussion about continuing treatment vs. palliative care. (I opted for palliative care and within several months she went into remission, which surprised us all.)

 

I'm not slamming vets; they need to make a living too, but I do prefer vets who are willing to work with me and discuss *all* options and not push only the most expensive/difficult solution.

 

As for the OP, she said her dog had been recently seen, so all the comments about people who don't take their dogs in regularly don't really apply here. I understand the argument that the vet may still need hands on, but I'd be willing to bet that had the urinalysis shown nothing remarkable, Jovi would have taken her dog in for follow up. I don't expect my vet to diagnose over the phone, but I also try to have a good relationship and good communication with my vet so that when I do call with a question/concern he may well be willing to discuss it with me without actually seeing the dog at that moment.

 

If I had a vet who routinely was adding procedures and products I didn't want or who wouldn't listen to my ideas or concerns regarding the path forward with treating my animals, I'd be looking for another vet.

 

J.


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#17 GentleLake

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Posted 28 August 2017 - 10:28 AM

I have no problem with vet prices in general - in fact, short of the times there was something I didn't ask for or wasn't told I was being given and then being asked for, I don't believe I've ever complained.  I know vets are far from raking in money when dealing with student debt, and operating businesses.  As well as dealing with people complaining that they're in it for the money and working in a really emotionally brutal field.

 

Yes, this.

 

Liz, in the instance I cited of the unauthorized dental cleaning, the dog had been examined less than a week prior and the vet found nothing concerning about his periodontal health, though only a physical exam was performed. Relating the encounter was meant to be anecdotal of unauthorized procedures and my unwillingness to pay for them.


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#18 waffles

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Posted 28 August 2017 - 12:04 PM

Smalahunder, no, it's not. Most vets keep their prices so low compared to their costs that the profession is hemorrhaging skilled employees, there is little to no profit margin and we cannot afford to pay back our student loans. We are actually drastically undercharge for our services. If something doesn't change, the profession will implode or will no longer attract the best and the brightest.


Do you think that is nation wide or your area? I live in western ny outside of Buffalo which has a pretty low cost of living (aside from high property taxes). We are certainly not like large wealthy cities in CA and yet there has been a trend in the past 5 years of vet practices (ones that have been around for decades) remodeling extensively.
In my small area there are 5 local vets that have either demolished their old buildings or put additions on that doubled or tripled there size. The buildings are nicer than most human doctors, with wifi, flat screen tv's, beautiful tile work and so on. My vet told me that the local vet in my small rural town spent 1.2 million dollars (if I remember correctly) on his new building. It's 3 stories with wrap around porch and all the crazy expensive equipment a vet could dream of (it won some award in a vet magazine too).

I keep wondering if there are some programs out there targeting vets with low interest loans for this work?
Some of the vets have added boarding or daycare as well but not all. It appears from the outside that vets in my area are doing very well. A bank wouldn't loan that money out if they weren't showing strong profits.
My SIL works for one of these places that tore down their old place and built a very large building. It has all the bells and whistles, it's gorgeous inside and out. The owners are husband and wife and she said they live in a subdivision in the wealthiest zip code in our area. They have 7 other vets on staff now. I would think at least the owners of these practices are making some good money. Maybe not so much the staff vets.
I fully am on board with supporting my vet who I love and I never complain about their prices. They have bills to pay and I know he has said he works 60+ hours/week. But their place is still quite modest compared to others around here. I just have always wondered about all these new large places that have gone up recently and if that is the trend elsewhere.

#19 gcv-border

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Posted 28 August 2017 - 08:55 PM

Just to be clear: I just asked my vet if I could drop off a urine sample for microscopic analysis ($40!). I had also already determined he had a normal TPR - which I also relayed to the vet. I didn't ask for medication. I figured that I would find out what the results were before I took the next step - which, in my mind, was to bring the dog in for sterile collection of urine if the results indicated bacteria.  I know that the sample I brought in was not a sterile sample.(Believe me, I know sterile technique after spending a decade or more of my life working at a tissue culture hood for 4-6 hours a day.) I have had a dog in the past who did not respond to the 'usual' antibiotic for clearing a UTI, and required a sterile sample to be sent out for bacterial identification (and subsequent Clavamox). As a result, I am sensitive to the need for culturing.

 

Also, the pee behavior in the house wasn't exactly what I had noticed as a prior behavior with a UTI. But since I know that not all behavior/symptoms are textbook and like to get a jump on any infection/disease, I will (if I think necessary) try to do any testing or get a check-up sooner rather than later.

 

Of course, I didn't see any evidence of inappropriate urination the day after I brought the sample in. (I guess I was a worry-wart.) And the household has continued clean to this day.

 

I am probably not the ideal client since I do not run to the vet for every little thing. I worked for over 2 decades as a research scientist, going on 2 decades with a herd of livestock for which I do vaccinations, worming, microchipping, taking blood samples, intubating, etc. and 4 decades of dog and cat ownership. I often question the what and why of any treaments the vet wants to do. I was quite spoiled by my large animal vet who would provide me with wormers, antibiotics, anti-inflammatories, mild tranqs, etc. as I needed them without having to examine every animal. But that was a relationship of trust that required several years to develop. She could trust I wasn't going to do something stupid.

 

Julie Poudrier wrote "As for the OP, she said her dog had been recently seen, so all the comments about people who don't take their dogs in regularly don't really apply here. I understand the argument that the vet may still need hands on, but I'd be willing to bet that had the urinalysis shown nothing remarkable, Jovi would have taken her dog in for follow up. I don't expect my vet to diagnose over the phone, but I also try to have a good relationship and good communication with my vet so that when I do call with a question/concern he may well be willing to discuss it with me without actually seeing the dog at that moment."  I agree with this outlook. [But the sample was negative, and I did not follow-up with a visit because the inappropriate urination stopped. If it had not, he would have been at the vet's post-haste.]

 

Part of the problem may have been the vet on duty (not my 'normal' vet). I had one visit with her and ended up with a huge vet bill. My older dog (8.5 years at the time) was acting a little 'off'. Not the energy he normally had and although he was eating all his food, it wasn't with the gusto he usually displayed. Was this a sign of aging or was it ehrlichia? I have noticed that ehrlichia can have very, very subtle signs. I brought him in for testing for TBDs. During the exam, the vet was suggesting the symptoms could represent this or that so she felt that we should take blood for a blood panel and CBC and then suggested an Xray would be a good idea.  ( I now forget her logic for the Xray.) So off she goes with Torque to the 'back' for sample collection and testing. After a very long time (I think the total visit was about 3 hours.), she came back with the dog and results. Excellent blood work and nothing abnormal on X-rays. Then I asked her about the results of the 4DX test (TBD test) - which was my original request - and she had never bothered to do it!!!  Bang head on wall.  Another 1/2 hour for that test - and yes, he had ehrlichia. If I had insisted she start with the 4DX test, and wait on the additional diagnostics until we had the results of that test, I could have save a lot of time and $$.

 

I don't begrudge the fees the vet charges, but at least use some common sense and don't overdo the testing/treatments.


Jovi

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#20 Sue R

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Posted 29 August 2017 - 08:18 AM

One thing I do find as an issue at my local, multi-vet practice (owned by a senior vet and staffed by a number of staff vets) is who answers the phone when I call. I know there have been problems getting new reception staff trained and following the rules and guidelines there (I know the office manager) but then the pendulum can swing in the opposite direction. A receptionist can follow the rules so strictly that it is counterproductive. 

 

If someone answers the phone that has been there a while and who knows me, the answer I get is usually quite different from the answer I'd get from new staff (who sometimes simply don't know what they are talking about, or sometimes are so rule-bound that they can't seem to be practical). 

 

It pays to get estimates, review them, and discuss them with your vet. Our daughter had her older dog in for an exam and it was found that he needed an extraction. She had already expressed her concern about ability to pay because she is a sole provider for her family and does not earn very much. She got an estimate of over $800 to remove one molar. I reviewed the estimate with her and we cut the cost in half by removing or reducing unnecessary expenses. One was about $200 for a dental. Now, if during the extraction it was found that a dental was needed, she would have had to do that but on the surface exam, it was not needed. One was an extensive blood panel when a less-extensive blood panel was sufficient. There were other "niceties" included in the estimate that she simply could not afford and that could be avoided. Had she had the funds to pay for it all, it might have been a good idea but she certainly did not. I helped her pay for some, she used Care Credit for half (and worked at our house once a month for several months to earn the money to pay that off), and she had been able to budget some money to pay for the rest. 

 

I am open and honest with my vet and she is with me. We discuss options, prices, alternatives, etc., and she never presses me to choose something that I feel is too expensive or doesn't look to return enough benefit for the cost. But at the end of the day, vets have to make a living and pay their bills, too. 

 

PS - When our vet practice had to move due to impending construction that would demolish the plain and simply building where they were located, the owner choose a nearby building "complex" that was much larger; had extensive renovations done; put in some costly upgrades (some were very practical but they certainly were not cheap); and so on. And the prices went up significantly. I notice though that human medical facilities do the same - always remodeling; making large and open spaces with huge areas to cool and heat that are not "productive"; and so on. People go, "Oh, this is so nice!" They should because they will be paying for it and it's nice that they like it. But not everybody can afford "so nice!" versus practicality and functionality. 


Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown


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